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Tranexamic acid after cardiopulmonary bypass does not increase risk of postoperative seizures: a retrospective study

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Abstract

Objective

To evaluate the effects of administering tranexamic acid (TXA) after cardiopulmonary bypass, instead of after anesthesia induction, on postoperative seizures and blood transfusion requirements.

Methods

Adult patients who underwent valve surgery and/or coronary artery bypass grafting at West China Hospital between July 1, 2011 and December 31, 2016 were retrospectively analyzed. Patients either received TXA after bypass (n = 2062) or not (n = 4236). Logistic regression and propensity score matching analysis were performed to assess effects of TXA on postoperative seizures and blood product requirements in hospital.

Results

Among 6298 patients, seizures occurred in 2.4% (102/4236) in the no-TXA group and 2.7% (56/2062) in the TXA group (P = 0.46). The number of patients receiving any blood products was greater in the no-TXA group (57.3%, 2428/4236) than in the TXA group (53.1%, 1095/2062) (P < 0.01), and the volume of blood products was also greater in the no-TXA group (1.5 vs. 1.0 units, P < 0.01). TXA was not associated with increased incidence of postoperative seizures (adjusted OR 1.16, 95% CI 0.83–1.62) but was associated with lower incidence of a requirement for blood products (adjusted OR 0.82, 95% CI 0.73–0.92). Similar results were obtained after patients from the two groups were matched based on propensity scoring. TXA was associated with reduced requirements for fresh frozen plasma, platelets and cryoprecipitate, but not red blood cells.

Conclusions

Administering TXA after bypass may reduce requirements for blood products without increasing risk of seizures following cardiac surgery.

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Acknowledgements

The authors would like to thank Professor Jerry Yu, M.D., Ph.D. in the Department of Pulmonary Medicine at the University of Louisville School of Medicine for advice and revision of the manuscript, and Dr. Linyu Tian in the Department of Neurology, West China Hospital, Sichuan University for the diagnosis of postoperative seizures.

Funding

This work was supported by the 1.3.5 Project for Disciplines of Excellence, West China Hospital of Sichuan University (20HXJS004 to LD).

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Authors and Affiliations

  1. Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Changwei Chen, Jing Liu & Lei Du

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  1. Changwei Chen
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  2. Jing Liu
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  3. Lei Du
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Contributions

Conceptualization: LD, JL. Data curation: CC, JL. Formal analysis: CC, JL. Funding acquisition: LD. Investigation: CC, JL. Methodology: CC, JL, LD. Project administration: CC, JL. Supervision: CC, JL, LD. Writing—original draft: CC, JL. Writing—review and editing: LD, CC.

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Correspondence to Lei Du.

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Jing Liu has no conflict of interest. Changwei Chen has no conflict of interest. Lei Du has no conflict of interest.

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Chen, C., Liu, J. & Du, L. Tranexamic acid after cardiopulmonary bypass does not increase risk of postoperative seizures: a retrospective study. Gen Thorac Cardiovasc Surg 70, 337–346 (2022). https://doi.org/10.1007/s11748-021-01709-y

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  • DOI: https://doi.org/10.1007/s11748-021-01709-y

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